Risk and Response-Adapted Treatment in Multiple Myeloma

Abstract

Myeloma therapeutic strategies have been adapted to patients’ age and comorbidities for a long time. However, although cytogenetics and clinical presentations (plasmablastic cytology; extramedullary disease) are major prognostic factors, until recently, all patients received the same treatment whatever their initial risk. No strong evidence allows us to use a personalized treatment according to one cytogenetic abnormality in newly diagnosed myeloma. Retrospective studies showed a benefit of a double autologous transplant in high-risk cytogenetics according to the International Myeloma Working Group definition (t(4;14), t(14;16) or del(17p)). Moreover, this definition has to be updated since other independent abnormalities, namely gain 1q, del(1p32), and trisomies 5 or 21, as well as TP53 mutations, are also prognostic. Another very strong predictive tool is the response to treatment assessed by the evaluation of minimal residual disease (MRD). We are convinced that the time has come to use it to adapt the strategy to a dynamic risk. Many trials are ongoing to answer many questions: when and how should we adapt the therapy, its intensity and duration. Nevertheless, we also have to take into account the clinical outcome for one patient, especially adverse events affecting his or her quality of life and his or her preferences for continuous/fixed duration treatment.

High Carbohydrate Diet Is Associated with Severe Clinical Indicators, but Not with Nutrition Knowledge Score in Patients with Multiple Myeloma

“…The International Staging System, which is based on serum beta-2 microglobulin and albumin levels, is the most widely adopted in multiple myeloma and is also correlated with the prognosis of the disease [40]. Assessment of bone marrow involvement by malignant plasma cells is an important element in the diagnosis and follow-up of patients with multiple myeloma and other plasma cell dyscrasias [40,41].…”

Anti‐CD19 and anti‐BCMA CAR T cell therapy followed by lenalidomide maintenance after autologous stem‐cell transplantation for high‐risk newly diagnosed multiple myeloma

“…After initial induction, high‐dose therapy and ASCT followed by IMiDs and/or PIs maintenance, prolongs PFS and OS in high‐risk NDMM; however, most patients eventually relapse and suffer early death 23 . In this single‐center, single‐arm, exploratory clinical trial, which to the best of our knowledge is the first of its kind, we found that posttransplant infusion of autologous dual‐antigen–targeting (anti‐CD19 and anti‐BCMA) CAR T cells followed by lenalidomide maintenance shows promising efficacy and favorable safety.…”

The Role of DNA Repair in Genomic Instability of Multiple Myeloma

“…Despite the significant advancements in therapeutics for MM patients, MM remains an incurable disease characterized by multiple remissions and relapses. The current clinical practice focuses on identifying high-risk patients and increasing the quality of life [ 117 , 118 ]. High-risk patients are determined based on many features, including frailty status, aggressiveness in clinical presentation, cytogenic abnormalities, mutations, biochemical abnormalities, prognostic scores, and the ISS risk model [ 119 ].…”